Doctors, Social Media, and Ethics

Social media has complicated the doctor-patient relationship beyond the exam room. (Photo by PhotoDu.de)

Do doctors have an ethical obligation to participate in social media? Dr. Wendy Sue Swanson thinks so. The Seattle-area pediatrician, mom, and blogger, talked about doctors and patients in the social space at Seattle Children’s eighth annual conference on pediatric bioethics in late July, along with Dr. Jennifer Kesselheim and Dr. John Lantos. The three doctors each presented their own takes on the issue before fielding questions collectively from moderator Holly Tabor, PhD and the audience of 200+ attendees from around the country and world. Though this was not a “social media” conference, the topic was a clear fit for this year’s theme of the ethical issues that arise from the “collision” of the professional and personal personas of medical providers.

For her part, Dr. Swanson spoke about the need for doctors to meet patients (or their parents, in the case of most pediatricians) where they are. And with 80% of internet users searching online for health information (according to a 2010 study by the Pew Internet and American Life Project) it’s clear that where they are is online. At a time when anyone can launch a blog or a website to share their views with the world, Swanson believes doctors must show up as trusted experts in the digital realm. Forums such as blogs, Twitter, and Facebook offer a good platform to do so.

Dr. Kesselheim agreed that doctors, “have an emerging duty to meet [patients] in an electronic space.” At the same time, she believes that policies and education are needed “problems of professionalism” arising from social media use particularly for medical residents. These problems include the usual social media kerfuffles, like posting off-color comments to your personal account that can actually be seen by the public or sharing TMI photos or status updates about your weekend revelries. All these things could (and do) happen to anyone, but for doctors the consequences are deeper. Online indiscretions not only reflect badly on the poster, but also on the entire medical profession.

And the consequences of a social media “overshare” may be different for doctors than other professionals. If you saw a tweet from your tax attorney saying she was headed into work exhausted and hungover, you might be unphased, while the same tweet from your surgeon might lead you to look for a new one.

The subject of doctors and patients being “friends” — the Facebook kind, but also in real life — was one that came up throughout the day. As Dr. Lantos put it, “The idea of doctors ‘friending’ patients is a little weird and a little icky,” and though many seemed to agree with this statement, like with all ethics issues, there is a lot of gray area.

What if a patient’s parents “friend” you on Facebook and you deny their request? What if you accept the request and then learn personal and intimate information about your patient or their family that they haven’t shared with you elsewhere? What impact might either of these scenarios have on a doctor’s continued professional relationship with their patient and his/her family? These are the questions that make it difficult for one to say, “doctors should never be ‘friends’ with patients, ever, for any reason.”

These are likely some of the “new challenges to the patient-physician relationship” the American Medical Association (AMA) makes note of in their policy on Professionalism and Social Media. The AMA also recognizes that social media offers the “opportunity to widely disseminate public health messages and other health communication.” For doctors like Swanson, benefits like this greatly outweigh the potential risks. And though she is a fierce advocate for doctors participating authentically, and fully as themselves online — sharing their personal experiences as well as their professional expertise — she’s also in favor of maintaining professional boundaries. She doesn’t accept friend requests from patients, but also says she doesn’t receive many. She uses her blog and Twitter account to share new information and research, and answer general questions she hears from parents in and out of the exam room, but steers clear of answering specific medical questions.

What do you think? Are you connected with your own or other doctors in the social media space? Would you ever want to “friend” your doctor? Do you wish more doctors were active online? Share your thoughts in the comments.

Dominique is a student in the MCDM program at the University of Washington, and works full-time at Seattle Children's as a social media specialist. Born and raised in the Pacific Northwest, she loves Seattle, but more so when the sun's out.